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Prevalence of dengue and leptospirosis coinfection and associated mortality rates: a systematic review and meta-analysis

Tiwari S 1 , Khatib MN 2 , Mm R 3 , Kaur M 4 , Sharma GC 5 , Sudan P 6 Show all authors , Naidu KS 7 , Singh R 8 , Vishwakarma T 9 , Puri S 10 , Shabil M 11 , Yadav A 12 , Singh T 13 , Khurana S 14 , Mehta R 15 , Satapathy P 16 , Sah R 17 , Gaidhane AM 18 , Bushi G 19

Affiliations 

  • 1 Department of Pharmacy Practice, National Institute of Pharmaceutical Education and Research, Guwahati, 781101, India
  • 2 Division of Evidence Synthesis, Global Consortium of Public Health and Research, Datta Meghe Institute of Higher Education, Wardha, India
  • 3 Department of Chemistry and Biochemistry, School of Sciences, JAIN (Deemed to be University), Bangalore, Karnataka, India
  • 4 Department of Allied Healthcare and Sciences, Vivekananda Global University, Jaipur, Rajasthan, 303012, India
  • 5 Department of Applied Sciences-Chemistry, NIMS Institute of Engineering & Technology, NIMS University Rajasthan, Jaipur, India
  • 6 Department of Pharmacy Chandigarh Pharmacy College, Chandigarh Group of Colleges-Jhanjeri, Mohali, 140307, Punjab, India
  • 7 Department of Chemistry, Raghu Engineering College, Visakhapatnam, 531162, Andhra Pradesh, India
  • 8 Uttaranchal Institute of Technology, Uttaranchal University, Dehradun, 248007, Uttarakhand, India
  • 9 IES Institute of Pharmacy, IES University, Bhopal, 462044, Madhya Pradesh, India
  • 10 New Delhi Institute of Management, Tughlakabad Institutional Area, New Delhi, India
  • 11 Center for Global Health Research, Saveetha Institute of Medical and Technical Sciences, Saveetha Medical College and Hospital, Saveetha University, Chennai, India
  • 12 Graphic Era Institute of Medical Sciences, Graphic Era (Deemed to be University, Clement Town, Dehradun, India
  • 13 Centre of Research Impact and Outcome, Chitkara University, Rajpura, Punjab, 140417, India
  • 14 Chitkara Centre for Research and Development, Chitkara University, Himachal Pradesh, 174103, India
  • 15 Clinical Microbiology, RDC, Manav Rachna International Institute of Research and Studies, Faridabad, 121004, Haryana, India
  • 16 University Center for Research and Development, Chandigarh University, Mohali, Punjab, India
  • 17 SR Sanjeevani Hospital, Kalyanpur, 56517, Siraha, Nepal. renusahdoc@gmail.com
  • 18 Global Health Academy, School of Epidemiology and Public Health, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education, Wardha, India. abhay.psm@dmiher.edu.in
  • 19 School of Pharmaceutical Sciences, Lovely Professional University, Phagwara, India
BMC Infect Dis, 2025 Jan 24;25(1):111.
PMID: 39856559 DOI: 10.1186/s12879-025-10498-1

Abstract

BACKGROUND: Dengue and leptospirosis are prominent vector-borne diseases in tropical and subtropical regions, sharing overlapping geographic distribution and clinical presentations, which complicates diagnosis and management. Co-infection of these pathogens places additional strain on healthcare resources in endemic areas. This study aims to systematically estimate the prevalence and mortality rates of dengue and leptospirosis co-infections and assess their clinical implications.

METHODS: Adhering the PRISMA 2020 guidelines and registered in the PROSPERO database, we conducted a systematic review and meta-analysis using the PubMed, Embase, and Web of Science databases up to October 2024. Nested Knowledge was used for screening and data extraction. Studies reporting quantitative data on the prevalence or mortality of dengue and leptospirosis co-infections were included. Data extraction and quality assessment were performed independently by two reviewers using the Modified Newcastle-Ottawa Scale. Statistical analyses, including prevalence and mortality estimation, sensitivity analysis were conducted using R, with heterogeneity evaluated by the I² statistic.

RESULTS: Out of 3,982 records, 14 studies met the eligibility criteria, yielding a pooled prevalence of dengue and leptospirosis co-infection at 2.33% (95% CI: 1.41-3.46%) across 16,638 participants, with significant heterogeneity (I² = 90%). The prediction interval for co-infection ranged from 0.05 to 7.27%. The pooled mortality rate among co-infected patients was 9.96% (95% CI: 0-53.49%), with moderate heterogeneity (I² = 71%). The prediction interval for mortality ranged from 0.00 to 100%. Publication bias was indicated by an LFK index of 2.52.

CONCLUSION: This meta-analysis revealed a moderate prevalence and a notable mortality rate for dengue and leptospirosis co-infections, with significant variability observed across different studies. Further research into the immunopathology and the implementation of integrated surveillance systems could enhance the effectiveness of diagnosis and treatment strategies in regions where these diseases are endemic.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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